ICPR Junior College and SIMTICS: Improving students’ clinical skills through web-based simulations

By Dr. Mónica Cerejido Ruiz and Prof. Noris Colón Pagán

[This article is translated from the original Spanish]

ICPR Junior College is an educational institution on the Caribbean island of Puerto Rico with over 70 years’ history of preparing future professionals for the workforce. The institution has five (5) locations around the island with a range of academic offerings that include associate degrees, certificates and continued education in the fields of healthcare, business administration, gastronomy, education, information systems and criminal investigation among others. The healthcare department offers programs in nursing, clinical ultrasound, radiologic technology, and therapeutic massage.

The students of ICPR Junior College come from a wide variety of backgrounds. Youths and adults come from rural as well as urban areas looking for a short career program with good employment possibilities. Many of them are non-traditional students; they work while they study and often have families to look after.  They come from different social classes and many of them are first generation students with great aspirations for personal improvement despite social and economic difficulties.

Facing challenges in health care education

ICPR Junior College has encountered the typical challenges that most educational institutions that offer health courses are dealing with. Among these challenges is the emphasis that has emerged on the prevention of medical errors and the approach to patient safety, as well as other changes in the provision of health services. As a result, health centers, hospitals, clinics and medical offices have limited the opportunities for students to obtain an externship placement to practice the clinical skills that are necessary before they encounter real-life scenarios. For the college, this created the need to research and implement alternative strategies of learning, practice, and evaluation.

The other challenge that the college faced was the limited practice time available in our laboratories because of the number of students and the limited equipment available. This was a particularly acute problem in medical sonography where key objectives can only be met with repeated practice.  With the difficulty for students to practice with real patients, we determined that the required skills could potentially be obtained by simulation.

We therefore recognized that we needed changes in the traditional instructional methods that we were using in the medical area. The importance of competencies in clinical abilities has been emphasized which is considered part of an essential apprenticeship for students. New pedagogic support in health sciences is needed: before, teaching was centered on acquiring a wide volume of knowledge and now it’s centered on achieving the integration of clinical scenarios where learned skills can be put into practice and applied to different situations.

With our CIO advising us on advances in technology, we began looking for an affordable simulation-based education resource to enhance our allied health curriculum.

We knew, by experience and from the literature, that student satisfaction has a positive impact in their motivation and retention, giving positive attitudinal and cognitive results. Therefore we wanted to choose a clinical simulation product that would be both attractive and effective for the student.

We also knew that the ability to transfer knowledge or performance acquired with simulations into real scenarios, continues to be one of the biggest and most important challenges in education.

ICPR students working through a sonography simulation

Web simulations provide the solution

When we discovered SIMTICS we saw that the simulations would give us the capability to reproduce clinical scenarios, the opportunity of finding and responding to abnormal or critical findings in a standardized and secure environment, and the possibility of using individual performance metrics to track student progress and mentor them to success.

ICPR students in the computer lab

In ICPR Junior College the students take classes both on-site and in a blended format. We have successfully incorporated the use of SIMTICS simulations in our allied health courses in both formats. We have used SIMTICS as learning support in anatomy, protocols, processes and patient management, among others. For assessment, we have used it to measure performance and knowledge of important clinical skills through the simulations and quizzes incorporated in the modules, assignments, and investigation projects, individually and in group forms. These simulations have proven to be both attractive and effective for our students.

We have found that SIMTICS is a great tool. It was a wise decision for us to present it to the administrators of the institution not only as a solution to the challenges we were experiencing, but also to continue offering the highest quality in education.

Student views

In an action research study carried out in 2019, with 53 clinical sonography students of ICPR Junior College where simulations were used, including SIMTICS, some of the results obtained were:

  • 96% of students considered they achieved the course objectives;
  • 94% of students felt confident to apply their knowledge in other courses, in a job or in their everyday lives;
  • 83% perceived simulation as a useful method for learning;
  • 82% learned and improved scanning skills, machine operation and patient handling;

In addition, 86% of students agreed that the simulation scenarios presented were quite realistic and the same percentage also expressed that it was useful to observe errors, review them and fix them.

Also, the majority said they gained knowledge that went beyond the original objectives outlined in the course and they felt they improved their technical skills. In general, the students were really satisfied with the experience of the simulation.

We have been using SIMTICS in our medical imaging programs for about five years now. For us, as ultrasound professors, the structure of the SIMTICS modules with updated protocols and user-friendly interface have been of great value for both the professor and the student. Also, the opportunity that SIMTICS provides for students to use trial and error, and to repeat over and over until acquiring the required skill, are critical for successful learning. The new tests with selectable time limits make interesting challenges for the students and are closer to the license exam experience.  

We see in SIMTICS a valuable tool to reinforce clinical skills so the student can practice according to their own learning needs, at any time and any place. We are very satisfied and know that with the SIMTICS tools available to our students, ICPR Junior College finds itself to be a vanguard in health courses in Puerto Rico, which gives us a significant competitive advantage over other institutions. We recommend SIMTICS to other health and science education colleagues to improve professor performance and student learning.


The SimTutor team would like to thank Dr. Ruiz and Prof. Pagán at ICPR Junior College for contributing this article, and Nelson Mejias, the CIO, for facilitating it.

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